Efficacy of Biological-Targeted Treatments in Takayasu Arteritis: Multicenter, Retrospective Study of 49 Patients

Circulation. 2015 Nov 3;132(18):1693-700. doi: 10.1161/CIRCULATIONAHA.114.014321. Epub 2015 Sep 9.


Background: The goal of this work was to assess the safety and efficacy of biologics (ie, tumor necrosis factor-α antagonists and tocilizumab) in patients with Takayasu arteritis.

Methods and results: This was a retrospective, multicenter study of the characteristics and outcomes of 49 patients with Takayasu arteritis (80% female; median age, 42 years [20-55 years] treated by tumor necrosis factor-α antagonists [80%] or tocilizumab [20%]) and fulfilling American College of Rheumatology or Ishikawa criteria. Factors associated with complete response were assessed. Eighty-eight percent of patients with Takayasu arteritis were inadequately controlled with or were intolerant to conventional immunosuppressive therapy (median number, 3 [1-5]). Overall response (ie, complete and partial) to biological-targeted treatments at 6 and 12 months was 75% and 83%, respectively. There were significantly lower C-reactive protein levels at the initiation of biological-targeted treatments (22 mg/L [10-46 mg/L] versus 58 mg/L [26-76 mg/L]; P=0.006) and a trend toward fewer immunosuppressants drugs used before biologics (P=0.054) in responders (ie, complete or partial responders) relative to nonresponders to biological-targeted treatments. C-reactive protein levels and daily prednisone dose significantly decreased after 12 months of biological-targeted treatments (30 versus 6 mg/L [P<0.05] and 15 versus 7.5 mg [P<0.05] at baseline and 12 months, respectively). The 3-year relapse-free survival was 90.9% (83.5%-99%) over the biological treatment period compared with 58.7% (43.3%-79.7%; P=0.0025) with disease-modifying antirheumatic drugs. No difference in efficacy was found between tumor necrosis factor-α antagonists and tocilizumab. After a median follow-up of 24 months (2-95 months), 21% of patients experienced adverse effects, with biological-targeted treatments discontinued in 6.6% of cases.

Conclusion: This nationwide study shows a high efficacy of biological-targeted treatments in refractory patients with Takayasu arteritis with an acceptable safety profile.

Keywords: Takayasu arteritis; biological therapy; treatment outcome; vasculitis.

Publication types

  • Comparative Study
  • Multicenter Study

MeSH terms

  • Adalimumab / adverse effects
  • Adalimumab / therapeutic use
  • Adult
  • Angiography
  • Antibodies, Monoclonal, Humanized / adverse effects
  • Antibodies, Monoclonal, Humanized / therapeutic use*
  • Antirheumatic Agents / adverse effects
  • Antirheumatic Agents / therapeutic use*
  • Blood Sedimentation
  • C-Reactive Protein / analysis
  • Disease-Free Survival
  • Drug Evaluation
  • Drug Resistance
  • Drug Therapy, Combination
  • Etanercept / adverse effects
  • Etanercept / therapeutic use
  • Female
  • Humans
  • Infliximab / adverse effects
  • Infliximab / therapeutic use
  • Male
  • Middle Aged
  • Molecular Targeted Therapy* / adverse effects
  • Prednisone / therapeutic use
  • Proportional Hazards Models
  • Retrospective Studies
  • Takayasu Arteritis / blood
  • Takayasu Arteritis / diagnostic imaging
  • Takayasu Arteritis / drug therapy*
  • Treatment Outcome
  • Tumor Necrosis Factor-alpha / antagonists & inhibitors*
  • Young Adult


  • Antibodies, Monoclonal, Humanized
  • Antirheumatic Agents
  • Tumor Necrosis Factor-alpha
  • C-Reactive Protein
  • Infliximab
  • Adalimumab
  • tocilizumab
  • Etanercept
  • Prednisone